Fraccaro, P, Kontopantelis, E, Sperrin, M, Peek, N, Mallen, C, Urban, P, Buchan, I and Mamas, M ORCID: https://orcid.org/0000-0001-9241-8890 (2016) Predicting Mortality from Change-over-time in the Charlson Comorbidity Index: A retrospective cohort study in a data-intensive UK health system. Medicine, 95 (43). e4973.

[img]
Preview
Text
medi-95-e4973.pdf - Published Version
Available under License Creative Commons Attribution.

Download (229kB) | Preview
[img] Text
Manuscript_revised.docx - Accepted Version
Available under License Creative Commons Attribution.

Download (108kB)
[img] Text
Supplementary material_revised.docx - Supplemental Material
Available under License Creative Commons Attribution.

Download (334kB)
[img] Text
Table1.docx - Supplemental Material
Available under License Creative Commons Attribution.

Download (19kB)
[img] Text
Table2.docx - Supplemental Material
Available under License Creative Commons Attribution.

Download (14kB)
[img] Text
Table3.docx - Supplemental Material
Available under License Creative Commons Attribution.

Download (13kB)
[img] Text
Table5.docx - Supplemental Material
Available under License Creative Commons Attribution.

Download (13kB)

Abstract

Multimorbidity is common among older people and presents a major challenge to health systems worldwide. Metrics of multimorbidity are, however, crude: focusing on measuring comorbid conditions at single time-points rather than reflecting the longitudinal and additive nature of chronic conditions. In this paper, we explore longitudinal comorbidity metrics and their value in predicting mortality.
Using linked primary and secondary care data, we conducted a retrospective cohort study on adults in Salford, UK from 2005 to 2014 (n = 287,459). We measured multimorbidity with the Charlson Comorbidity Index (CCI) and quantified its changes in various time windows. We used survival models to assess the relationship between CCI changes and mortality, controlling for gender, age, baseline CCI, and time-dependent CCI. Goodness-of-fit was assessed with the Akaike Information Criterion and discrimination with the c-statistic.
Overall, 15.9% patients experienced a change in CCI after 10 years, with a mortality rate of 19.8%. The model that included gender and time-dependent age, CCI, and CCI change across consecutive time windows had the best fit to the data but equivalent discrimination to the other time-dependent models. The absolute CCI score gave a constant hazard ratio (HR) of around 1.3 per unit increase, while CCI change afforded greater prognostic impact, particularly when it occurred in shorter time windows (maximum HR value for the 3-month time window, with 1.63 and 95% confidence interval 1.59–1.66).
Change over time in comorbidity is an important but overlooked predictor of mortality, which should be considered in research and care quality management.

Item Type: Article
Uncontrolled Keywords: Charlson Comorbidity Index, comorbidity, multimorbidity, prognostic impact, retrospective cohort study, risk stratification, Salford Integrated Record, survival analysis
Subjects: R Medicine > R Medicine (General)
Divisions: Faculty of Medicine and Health Sciences > Institute for Science and Technology in Medicine
Depositing User: Symplectic
Date Deposited: 15 Sep 2016 11:32
Last Modified: 08 Apr 2019 08:55
URI: http://eprints.keele.ac.uk/id/eprint/2171

Actions (login required)

View Item View Item